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Helene Pavlov, M.D.

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More Insight on "Not All Images Are Created Equal"

Posted: 08/19/09 03:50 PM ET

Over the next few weeks I will be posting excerpts from an article in RT Image. Some of the questions and answers in this piece further highlight my position that "not all medical radiology images are created equal." You can read the full article here.

One of the key reasons health care is exploding is linked to medical imaging. A predominant factor in this explosion is related to non-radiology owned private practices and imaging centers and self referral. Self referral is perpetuated by patient convenience and a "one stop shopping" concept, however, underlying this statement is the incentive to increase the bottom line of their practice. Compounding this process is that the vendors of medical equipment make it appealing for a private practice to purchase its own imaging equipment. RT Image wanted to know if this is a new trend or has it always been easy for non-radiologists to purchase their own equipment.

My response included the following:

Most vendors will sell to anyone that has the money to buy the equipment. You look at the stock market and these companies are in trouble. They need to sell equipment -- that's how they make their profit. Specifically with less expensive equipment such as ultrasound and extremity MR units. The vendors emphasize to potential buyers that, "You're not going to do any damage to the patient; you're not going to be using ionizing radiation."

[Untrained physicians] feel as though there's a magic button that they will press that will give them an image, and they will either rely on the technologist or the sonographer to get the image; expertise and quality control parameters for image acquisition may or may not exist within their practice. Once they have the image, they may then send it to India or to some teleradiology service for a low-cost interpretation, or they will read it themselves thinking they have the necessary expertise, which they may or may not have.

Non-radiology physicians do not fall under the scrutiny of the American Board of Radiology which requires written and oral examinations and verification of four years of training to be a board-certified radiologist. Non-radiology physicians do not get extensive training in imaging and their certification boards do not test for imaging expertise. Patients and possibly third-party payers are not always informed accordingly and may not be aware of the importance and difficulty of achieving quality images. They may also not recognize the difference between the interpretation by a radiologist who does not self refer and a non-radiologist physician who may benefit by generating the need for additional self referred imaging examinations.

HSS